Drug-Induced Hypersensitivity Syndrome: A Clinical, Radiologic, and Histologic Mimic of Lymphoma
Table 1
Comparison of clinical and pathologic features of DIHS, classic Hodgkin’s lymphoma, and angioimmunoblastic T-cell lymphoma. IGH: immunoglobulin heavy chain. TCR: T-cell receptor.
Drug-induced hypersensitivity syndrome (DIHS)
Classic Hodgkin’s Lymphoma (CHL)
Angioimmunoblastic T-cell lymphoma (AITL)
Clinical presentation
Age
Any age
Young adult or bimodal distribution, depending on subtype
Middle age to elderly
Lymphadenopathy
Present
Present
Present
B symptoms
Present
Present
Present
Skin rash
Present
Absent
Frequently present
History of drug exposure
Present
Absent
Absent
Prognosis
Excellent
Good
Poor
Morphology
Reed–Sternberg-like cells
May be present
Present
May be present
Lymph node architecture
May be significantly distorted, but generally at least partially preserved
Effaced
Variably effaced; residual germinal centers may be present
Inflammatory cells (i.e., eosinophils)
Present
Present
Present
Vascular proliferation
Present
Absent
Present
Immunophenotype
CD30 (in large cells)
+
+
+
CD15 (in large cells)
−
+
−
CD45 (in large cells)
+
−
+
T-cell population
Usually normal; may show diminished expression of one or more pan-T-cell markers
Normal; CD4:CD8 ratio usually increased
Abnormal; usually CD4 positive, with expression of follicular helper T-cell markers (PD1, CXCL13, BCL6, and CD10)
Molecular abnormalities
No clonal IGH or TCR gene rearrangements
Clonal IGH gene rearrangement may be detected, particularly in microdissected tissue
